安寧療護的理論與實踐及其對戰後台灣醫療史的意義

The Theories and Practice of Hospice Care and Its Significance to the History of Post-war Taiwan Medical Services

周宴竹(Yen-Chu Chou)

指導教授 ： 王樾

淡江大學/文學院/歷史學系碩士在職專班/碩士(2010年)

https://doi.org/10.6846/TKU.2010.01105

摘要

近年來，台灣每年四萬多名死於癌症的患者中，多數病患長期遭受身體的病痛、心理焦慮與沮喪，而且病患常於持續住院治療期間因不適或相關併發症而死亡。這不僅會造成國家社會的沉重醫療負擔，也因為傳統醫療方式無法妥善照顧，而使得病患與家屬生活品質低落。
安寧療護的興起，將許多更為人本的觀念注入傳統的醫療體系中，提供癌症末期患者另一種照護模式，是一個以家庭為照顧單位的全方位醫療。安寧療護的哲學和傳統醫療最大的不同在於：安寧療護光明正大地承認「人會死」，在這個前提之下，安寧療護所關注的是：當一個人的死亡是可以預期的時候，那麼醫療團隊該如何陪伴需受照顧的臨終者，這時醫療的目標從「治癒」轉為「照顧」，而安寧療護針對無法治癒之病患及其家屬提供整體的照顧，藉著解除疼痛或其他不適症狀，並統合心理、靈性上無微不至的照顧來提高病患及家屬的生活品質。所以安寧療護強調讓病患有身、心、靈、社會完整的層面，接受臨終照顧，得以平安、尊嚴地善終。
雖然安寧療護理念已逐漸推展開來，但長久以來，「死亡」一直是我們社會禁忌的話題。因無法正視這件生命中無法避免的大事，而衍生出許多個人及家庭的悲劇。藉著安寧療護的推展，讓末期病人得以善終，給予病患家屬精神上的支持，使坦然接受即將面對的問題。倡導民眾預立遺囑或「生預囑」，尊重臨終醫療自主權，並對死亡做好準備，使人們領悟生命的有限性，以不執著的人生態度，活出意義來。推廣展健康的生命教育，才能讓整個社會了解及接受安寧療護，進而認同與支持安寧療護的工作，是發展安寧療護努力的方向。

關鍵字

安寧療護 ； 癌末病患 ； 生死教育 ； 安樂死

並列摘要

For recent years, most of the forty thousand people in Taiwan who die of cancer have suffered from long-term pain, anxiety, and depression and even die from discomfort or related complications during the period when they are confined in the hospital to receive regular treatment. This brings the heavy medical burdens for the society and the nation; besides, because the traditional medical care fails to provide sufficient caring, the patients and their families have to tolerate lower quality of living.
As the rise of hospice care, more humanistic notions are provided to the system of the traditional medical services, giving the final-term patients of cancer another mode of caring and nursing. It is an all-round medical service that regards the family as the unit to take care of. The distinguished difference between the viewpoints of the hospice care and that of the traditional medical service is that the former allows people to face squarely the fact “All humans will die.” Under this pre-condition, what the hospice care concerns is what the team of the medical care could do to take care of the patients at deathbeds when their ends are predictable. Obviously, in place of healing, the target of medical care turns to caring and nursing. To promote the quality of living of the patients and their families, the hospice care aims at offering all-round cares to the incurable patients and their families by relieving pains and other uncomfortable symptoms as well as offering them cares in every possible way by integrating their mentality and spirits. Therefore, hospice care advocates the notion that allows the patients to die in peace and with dignity by means of giving them wholesome cares from physical, mental, and spiritual aspects.
Despite that the theories of hospice care have gradually developed and been advocated, the issue “death” has always been a taboo subject in our society for a long time. As this unavoidable destiny cannot be faced with square attitude by general people, many unnecessary tragedies of individual or of family occur. The practice of hospice care makes it possible for the final-term patients to die in peace and with dignity and for their families to obtain support. As a result, the patients and their families are able to encounter the coming doom squarely and composedly. To advocate patients to make wills before their death (living wills) and to respect their autonomy of choosing final medical service are important, which help people realize the limitation of life and make good preparations for death. Only through these ways can people outlive their lives without being confined in stubborn depression. In order to make hospice care understood and accepted, and, in consequence, supported by the public, to advocate positive life education, therefore, is the best way to promote the practice of hospice care.

並列關鍵字

Hospice Care ； Terminal stage Cancer patient ； Life-and-Death education ； Euthanasia

參考文獻

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